Clinical Outcomes of Teclistamab in the Real World for RRMM | Carlyn Rose Tan, MD | IMS 2024

Hello, my name is Carleen Tan. I'm a junior faculty member at Memorial Sloan Kettering Cancer Center in New York City treating multiple myeloma. On behalf of my colleagues, I wanted to present our abstract titled Clinical Outcomes of Ticlostomab Among Majestic One Eligible and Ineligible Population in the Real World Setting for the Treatment of Relapsed Refractory in Multiple Myeloma. Ticlostomab is the first BCMA CD3 bispecific antibody approved for triple class exposed relapsed refractory multiple myeloma based on the pivotal Majestic One study. We presented in this abstract an update of outcomes of real world ticlostomab patients that had initially been published by Dr. Firestone that now includes more patients and longer follow up time. Additionally, we know that patients enrolled in clinical trials per eligibility criteria are less frail and have fewer co-morbidities than patients in the general population. So we went ahead and examined the real world clinical outcomes of patients with relapsed refractory myeloma treated with ticlostomab based on the Majestic One eligibility criteria. So we conducted a retrospective study of patients treated at Memorial Sloan Kettering between November 29, 2022 to July 5, 2024 with data collected until July 31, 2024. We chose certain key Majestic One eligibility criteria to stratify patients as TEC-1 eligible versus ineligible including ECOG performance status of 0 or 1, no prior BCMA targeted therapy, no prior T cell redirecting therapy, certain laboratory value cutoffs that were required by the study. We included 96 patients in this analysis. For the overall cohort, the median age was 71. 72% had high risk cytogenetic abnormalities prior to initiation of ticlostomab. These were heavily pre-treated patients. The median prior lines of therapy was 6. 39% of patients had prior BCMA directed therapy including antibody drug conjugate, CAR T cell therapy and other bispecific antibodies. For the overall population, the overall response rate was 61%. For 88 responsive valuable patients including 48% with a very good partial response or better. For patients that had prior BCMA directed therapy, the overall response rate for our cohort was 44%. After a median follow-up time of 12.4 months, the 12-month PFS rate was 41.3%. The six-month duration of response rate was 78.8% with a median duration of response not reached. The 12-month overall survival rate was 61.6% and the median overall survival has also not been reached. Within our real-world cohort, the majority of patients would not have met Majestic I eligibility. 77% would not have met Majestic I eligibility criteria. Only 23% did or would have. Among the 74 ineligible patients, the most common reasons for ineligibility were cytopenias, prior BCMA directed therapy, creatinine clearance less than 40 milliliters per minute, and prior non-BCMA T cell redirecting therapy. The Majestic I ineligible cohort had more patients with high-risk cytogenetics compared to the eligible cohort. It was 81% versus 45%. The ineligible cohort also had more prior lines of therapy, so six versus four. In terms of outcomes, the overall response rate was 86% for the Majestic I eligible cohort and 54% for the Majestic I ineligible cohort. At the time of analysis cutoff, 68% of the Tech I eligible patients and 32% of the ineligible patients were able to transition to less frequent dosing based on reaching at least a partial response or for management of adverse events. After a median follow-up of 12.4 months, the unadjusted 12-month PFS rate was 64.2% for the Tech eligible patients and 33.7% for the Tech I ineligible patients. So in conclusion, in this real-world study, the Majestic I eligible patients demonstrated impressive overall response rates, 12-month PFS. However, in patients who would not have met Tech I eligibility despite significant disease burden and high-risk features, the unadjusted overall response rates were still good, comparable, and were comparable to the Majestic I trial.